Publication: Yenidoğanlarda topuk kanı alma sırasında oluşan ağrı ve stres düzeyine emzirme, anne sütü kokusu ve anne kalp atım sesinin etkisi
Abstract
Yenidoğanlarda Topuk Kanı Alma Sırasında Oluşan Ağrı ve Stres Düzeyine Emzirme, Anne Sütü Kokusu ve Anne Kalp Atım Sesinin EtkisiAmaç: Term yenidoğanlarda topuk kanı alma işlemi sırasında oluşan ağrı ve stres düzeyine emzirme, anne sütü kokusu ve anne kalp atım sesi yöntemlerinin etkisini belirlemek amacıyla yapıldı.Gereç ve Yöntem: Araştırmanın evrenini Muş Devlet Hastanesi’nde doğan yenidoğanlar, örneklemini ise 15 Şubat – 15 Temmuz 2019 tarihleri arasında örneklem kriterlerine uyan 90 yenidoğan oluşturdu. Araştırmanın verileri araştırmacılar tarafından literature uygun geliştirilen Veri Toplama Formu/ Uygulama Kayıt Formu ile ALPS-Neo Yenidoğan Ağrı ve Stres Değerlendirme Ölçeği, pulseoksimetre, fetal el doppler cihazı, ses kayıt cihazı ve hoparlör kullanıldı. Verilerin analizinde Shapiro Wilk testi frekans, Cohen’s Kappa değeri, Cronbach Alpha(α), Anova, Ki kare, Kruskal-Wallis testi, Mann-Whitney U testi ve Spearman's rho kullanıldı.Bulgular: İşlem öncesinde deney gruplarında ALPS-Neo ölçek puanları gruplararasında anlamlı fark bulunmadı (p>0.05). İşlem sırasında anne sütü kokusu grubundaki (7.56±3.08 puan) yenidoğanların yüksek düzeyde ağrı ve stresinin olduğu, anne kalp atım sesi grubundaki (4.13±3.44 puan) yenidoğanların hafif düzeyde ağrı ve stresinin olduğu ve emzirme grubundaki (1.13±2.63 puan) yenidoğanların ağrı ve stresinin olmadığı bulundu. İşlem esnasında ve işlem sonrasında KTA, SpO2 arasında anlamlı fark bulunmaz iken ağlama süreleri arasında anlamlı fark bulundu. En yüksek ağlama süresi anne sütü kokusu uygulanan grupta olup anne kalp atım sesi ve emzirme grubu sıralaması şeklindedir.Sonuç: Nonfarmakolojik ağrı yöntemlerinden emzirme ve anne kalp atım sesi yenidoğan ağrı yönetiminde etkilidir. Anne sütü kokusu ağrı kontrolünde etkili bir yöntem olarak bulunmamış olup etkinliği yeni çalışmalarla araştırılmalıdır.İÇİNDEKİLERTEZ ONAYIBEYANTEŞEKKÜR……………………………………………………………………………….......iİÇİNDEKİLER……………………………………………………………………………….iiKısaltmalar ve Simgeler Listesi ……………………………………………………………….viŞekiller Listesi ………………………………………………………………………………..viiTablolar Listesi ………………………………………………………………………………viiiEkler Listesi …………………………………………………………………………………...ix1. ÖZET……………………………………………………………………………….............12. SUMMARY………………………………………………………………………………...23. GİRİŞ ve AMAÇ…………………………………………………………………...............34. rının Tanımı ……………………………………………………………………………64.2. Ağrının Fizyolojisi ……………………………………………………………………......64.3. Ağrı Teorileri ……………………………………………………………………………...84.3.1. Kapı kontrol teorisi …………………………………………………………….………..84.3.2. Nöromatriks teorisi ……………………………………………………….……..………94.3.3. Endorfin salınım teorisi ……………………………….…………………………………94.3.4. İnteraktif ağrı modeli ……………….………………………………………………..….94.3.5. Spesifite (özgüllük) ağrı teorisi …………….………………………………………….104.3.6. Pattern (desen) teorisi ……………………………………………………………….…104.3.7. Yoğun teori ……………….……………………………………………………………104.3.8. Psikolojik teoriler ………….…………………………………………………………..104.4. Ağrı Sınıflandırması ………………………………………………………………..……114.4.1. Ağrının başlama süresine göre sınıflandırması ……………………………...…………114.4.2. Ağrının nörofizyolojik mekanizmalarına göre sınıflandırması ……………….……….124.4.3. Ağrının kaynaklandığı bölgeye göre sınıflandırılması…….……………………………134.4.4. Duyu şekline göre sınıflandırılması ……………………………………...…………….144.5. Yenidoğanın Tanımı ve Sınıflandırılması …………………………………..……….…...154.6. Yenidoğanda Duyu Organlarının Gelişimi ………………………………..……………..164.7. Yenidoğanda Ağrı ………………………………………...……………………………...194.7.1. Yenidoğan ağrısının gelişimsel boyutu ……………………..………………………….204.7.2. Yenidoğanda ağrı fizyolojisi ……………………………..…………………………….214.7.3. Yenidoğanda ağrı belirtileri ………………………………….………………………...214.7.4. Yenidoğanda ağrının etkileri …………………………………….…………………….224.7.5. Yenidoğanlarda ağrının değerlendirilmesi……………………..……………………….234.7.6. Yenidoğanda ağrı değerlendirme araçları ………..………………………………….....234.7.6.1. yenidoğan ağrı ve stres değerlendirme ölçeği ……………………..…………………254.7.7. Yenidoğanda ağrı yönetimi …………………………………………….……….……...264.7.7.1. farmakolojik yöntemler ……………………………………………...………….……274.7.7.2. nonfarmakolojik yöntemler ……………………………………………..……………334.8. Yenidoğan Tarama Testlerinde Ebe ve Hemşirelerin Görevi ……………………………424.9. Yenidoğanda Ağrı Kontrolü ve Yönetiminde Ebe ve Hemşirenin Rolleri ……...………...435. GEREÇ VE YÖNTEM …………………………………….……………………………..455.1. Araştırmanın Amacı ve Tipi ……………………………………………………………..455.2 Araştırmanın Yapıldığı Yer ve Zaman ……………………………………………………455.3. Araştırmanın Evren ve Örneklemi ……………………………………………………….455.4. Çalışmaya Alınma Kriterleri ……………………………………..……...……………….455.5. Çalışmadan Dışlanma Kriterleri ………………………………….....……………………465.6. Araştırmanın Değişkenleri ………………………………………….……………………465.7. Araştırmanın Hipotezleri …………………………………………….…………………..475.8. Veri Toplama Araçları ………………………………………………………..………….475.8.1. Veri toplama formu …………………………………………………………………….475.8.2. ALPS-Neo yenidoğan ağrı ve stres değerlendirme ölçeği …………...…………………475.8.3. Uygulama kayıt formu………………………………………….………………………485.8.4. Pulse oksimetre………………………………….……………………………………...485.8.5. Fetal el dopleri…………………………………………………………………..……...485.8.6. Ses kayıt cihazı……………………………….………………………………………...485.8.7. Hoparlör………………………………………………………………………………...485.9. Verilerin Elde Edilmesi………………………………………….……………………….485.9.1. Araştırmanın ön uygulaması……………………………………………………………495.9.2. Uygulanacak yaklaşım ve yöntemler……………………………...……………………495.10. Verilerin Analizinde Kullanılacak İstatistiksel Yöntemler……………………...………515.11. Araştırmanın Etik Yönü……………………………………………..…………………..515.12. Araştırmanın Sınırlılıkları……………………………………………………….………516. BULGULAR ………………………………………………………………………………566.1. Ölçek Toplam Puanlarına Göre Gözlemciler Arası Uyum Puanlarına İlişkin Bulgular…..566.2. Ölçek Cronbach Alpha Değerlerine İlişkin Bulgular………………………………..……576.3. Ebeveynlerin Demografik Verilerinin Dağılımına İlişkin Bulgular………………………576.4. Yenidoğanların Demografik Özelliklerine İlişkin Bulgular……………………..………..586.5. Yenidoğanların ALPS-Neo Ölçek Toplam Puanlarına İlişkin Bulgular………….………596.6. Yenidoğanların Kalp Tepe Atımı, SpO2 ve Ağlama Sürelerine İlişkin Bulgular…………606.7. ALPS-Neo Toplam Puanlarının Gestasyon Yaşı, Postnatal Yaş ve Doğum Ağırlığına İlişkin Bulgular………………………………………………………………..………………617. TARTIŞMA VE SONUÇ …….……………………………………………...……………627.1. Gruplardaki Yenidoğanların Tanıtıcı Özellikleri İle İlgili Bulguların Tartışılması ………637.2. Gruplardaki Yenidoğanların ALPS-Neo Ölçek Toplam Puanlarına Yönelik Bulguların Tartışılması ………………………………………………………………………...…………647.3. Gruplardaki Yenidoğanların Kalp Tepe Atımı, SpO2 ve Ağlama Sürelerine Yönelik Bulguların Tartışılması ……………………………………………………………….………667.4. Gruplardaki Yenidoğanların Gestasyon Yaşı, Postnatal Yaş ve Doğum Ağırlığına Yönelik Bulguların Tartışılması ……………………………………………………………….………687.5. Sonuç ………………………………………………………………………….…………697.6. Öneriler …………………………………………………………………………..………708. KAYNAKLAR …………………………………………………………...………….........729. EKLER …………………………………………………………………………...….........8110. ÖZGEÇMİŞ …………………………………………………………………..…………92
The Effect of Breastfeeding, Breast Milk Odor and Mother Heart Beat Sound on the Pain and Stress Level During Heel Blood Collection in Newborns.Objective: It was performed to determine the effect of breastfeeding, breast milk odor and maternal heart beat sound on the pain and stress level during heel prick in term newborns.Materials and Methods: The population of the study was the newborns born in Muş State Hospital, and the sample consisted of 90 newborns who met the sampling criteria between February 15 and July 15, 2019. Data Collection Form / Application Registration Form developed by the researchers in accordance with the literature and ALPS-Neo Neonatal Pain and Stress Assessment Scale, pulseoxymeter, fetal hand doppler device, voice recorder and loudspeaker were used. Shapiro Wilk test frequency, Cohen's Kappa value, Cronbach Alpha (α), Anova, Chi square, Kruskal-Wallis test, Mann-Whitney U test and Spearman's rho were used to analyze the data.Results: Before the procedure, there was no significant difference between the ALPS-Neo scale scores in the experimental groups (p>0.05). During the procedure, the newborns in the breast milk odor group (7.56 ± 3.08 points) had high levels of pain and stress, the newborns in the maternal heart beat sound group (4.13 ± 3.44 points) had mild pain and stress, and the newborns in the breastfeeding group (1.13 ± 2.63 points) had pain and stress. It was found to be stress free. While there was no significant difference between KTA and SpO2 during and after the procedure, a significant difference was found between crying times. The highest crying time is in the breast milk scent group and is in the order of the mother heart beat sound and breastfeeding group.Conclusion: Among non-pharmacological pain methods, breastfeeding and maternal heart beat sound are effective in neonatal pain management. Breast milk odor has not been found to be an effective method in pain control, and its effectiveness should be investigated with new studies.CONTENTSTHESIS APPROVALDECLARATIONTHANK YOU …………………………………………………………………………… ....... iCONTENTS …………………………………………………………………………… .iiList of Abbreviations and Symbols ……………………………………………………………… .viList of Figures …………………………………………………………………………… ..viiList of Tables …………………………………………………………………………… viiiList of Attachments ……………………………………………………………………………… ... ix1. SUMMARY …………………………………………………………………………… ............. 12. SUMMARY …………………………………………………………………………… ... 23. INTRODUCTION and OBJECTIVE ………………………………………………………………… ............... 34. Definition of Pain …………………………………………………………………………… 64.2. Physiology of Pain …………………………………………………………………… ...... 64.3. Theories of Pain …………………………………………………………………………… ... 84.3.1. Gate control theory ……………………………………………………………. ……… ..84.3.2. Neuromatrix theory ………………………………………………………. …… .. ……… 94.3.3. Endorphin release theory ………………………………. ………………………………… 94.3.4. Interactive pain model ………………. ……………………………………………… ..… .94.3.5. Specificity (specificity) pain theory ……………. ………………………………………… .104.3.6. Pattern theory ……………………………………………………………….… 104.3.7. Intensive theory ………………. …………………………………………………………… 104.3.8. Psychological theories …………. ………………………………………………………… ..104.4. Classification of Pain ……………………………………………………………… .. …… 114.4.1. Classification of pain according to onset …………………………… ... ………… 114.4.2. Classification of pain according to neurophysiological mechanisms ………………. ……… .124.4.3. Classification of pain according to the region of origin ……. …………………………… 134.4.4. Classification according to sense type …………………………………… ... …………… .144.5. Description and Classification of Newborn ………………………………… .. ……….… ... 154.6. Development of Sensory Organs in Newborns ……………………………… .. …………… ..164.7. Pain in Newborn ……………………………………… ... …………………………… ... 194.7.1. Developmental dimension of neonatal pain …………………… .. ………………………… .204.7.2. Pain physiology in newborn …………………………… .. …………………………… .214.7.3. Pain symptoms in the newborn …………………………………. ……………………… ... 214.7.4. Effects of pain in the newborn ……………………………………. …………………… .224.7.5. Pain assessment in newborns …………………… .. ……………………… .234.7.6. Pain assessment tools in newborn ……… .. ………………………………… ..... 234.7.6.1. newborn pain and stress rating scale …………………… .. ………………… 254.7.7. Pain management in newborn ……………………………………………. ………. …… ... 264.7.7.1. pharmacological methods …………………………………………… ... …………. …… 274.7.7.2. non-pharmacological methods …………………………………………… .. …………… 334.8. Duties of Midwives and Nurses in Newborn Screening Tests …………………………… 424.9. The Roles of the Midwife and Nurse in the Management and Management of Pain in Newborns …… ... ……… ... 435. MATERIAL AND METHOD ……………………………………. …………………………… ..455.1. Purpose and Type of the Research …………………………………………………………… ..455.2 Place and Time of the Study …………………………………………………… 455.3. Study Population and Sample ……………………………………………………… .455.4. Recruitment Criteria …………………………………… .. …… ... ……………… .455.5. Work Exclusion Criteria ………………………………… ..... …………………… 465.6. Variables of the Study …………………………………………. …………………… 465.7. Research Hypotheses ……………………………………………. ………………… ..475.8. Data Collection Tools ……………………………………………………… .. ………… .475.8.1. Data collection form ………………………………………………………………… .475.8.2. ALPS-Neo neonatal pain and stress rating scale ………… ... ………………… 475.8.3. Application registration form …………………………………………. ……………………… 485.8.4. Pulse oximeter …………………………………. …………………………………… ... 485.8.5. Fetal hand dopes ………………………………………………………………… .. …… ... 485.8.6. Voice recorder ………………………………. ……………………………………… ... 485.8.7. Speaker ……………………………………………………………………………… ... 485.9. Data Collection …………………………………………. ……………………… .485.9.1. Pre-application of the study …………………………………………………………… 495.9.2. Approaches and methods to be applied …………………………… ... …………………… 495.10. Statistical Methods to be Used in Data Analysis …………………… ... ……… 515.11. Ethical Aspect of the Study …………………………………………… .. ………………… ..515.12. Limitations of the Study ………………………………………………………. ……… 516. FINDINGS …………………………………………………………………………… 566.1. Findings Regarding Interobserver Compliance Scores According to Scale Total Scores… ..566.2. Findings Regarding the Cronbach Alpha Values of the Scale ……………………………… .. …… 576.3. Findings Regarding the Distribution of Parents' Demographic Data ……………………… 576.4. Findings Regarding the Demographic Characteristics of Newborns …………………… .. ……… ..586.5. Findings Regarding ALPS-Neo Scale Total Scores of Newborns …………. ……… 596.6. Findings Regarding Peak Heart Rate, SpO2 and Crying Time of Newborns ………… 606.7. Findings Regarding Gestational Age, Postnatal Age and Birth Weight of ALPS-Neo Total Scores ……………………………………………………………… .. ……………… 617. DISCUSSION AND CONCLUSION ……. …………………………………………… ... …………… 627.1. Discussion of Findings Regarding the Introductory Features of Newborns in the Groups ……… 637.2. Discussion of Findings Regarding ALPS-Neo Scale Total Scores of Newborns in Groups ……………………………………………………………………… ... ………… 647.3. Discussion of Findings Regarding Peak Heart Rate, SpO2 and Crying Time of Newborns in Groups ………………………………………………………………. ……… 667.4. Discussion of Findings Regarding Gestational Age, Postnatal Age and Birth Weight of Newborns in Groups ………………………………………………………………. ……… 687.5. Result …………………………………………………………………………. ………… 697.6. Suggestions ………………………………………………………………………… .. ……… 708. RESOURCES ………………………………………………………… ... ………… ......... 729. ANNEXES ……………………………………………………………………… ...… ......... 8110. CV ………………………………………………………………… .. ………… 92
The Effect of Breastfeeding, Breast Milk Odor and Mother Heart Beat Sound on the Pain and Stress Level During Heel Blood Collection in Newborns.Objective: It was performed to determine the effect of breastfeeding, breast milk odor and maternal heart beat sound on the pain and stress level during heel prick in term newborns.Materials and Methods: The population of the study was the newborns born in Muş State Hospital, and the sample consisted of 90 newborns who met the sampling criteria between February 15 and July 15, 2019. Data Collection Form / Application Registration Form developed by the researchers in accordance with the literature and ALPS-Neo Neonatal Pain and Stress Assessment Scale, pulseoxymeter, fetal hand doppler device, voice recorder and loudspeaker were used. Shapiro Wilk test frequency, Cohen's Kappa value, Cronbach Alpha (α), Anova, Chi square, Kruskal-Wallis test, Mann-Whitney U test and Spearman's rho were used to analyze the data.Results: Before the procedure, there was no significant difference between the ALPS-Neo scale scores in the experimental groups (p>0.05). During the procedure, the newborns in the breast milk odor group (7.56 ± 3.08 points) had high levels of pain and stress, the newborns in the maternal heart beat sound group (4.13 ± 3.44 points) had mild pain and stress, and the newborns in the breastfeeding group (1.13 ± 2.63 points) had pain and stress. It was found to be stress free. While there was no significant difference between KTA and SpO2 during and after the procedure, a significant difference was found between crying times. The highest crying time is in the breast milk scent group and is in the order of the mother heart beat sound and breastfeeding group.Conclusion: Among non-pharmacological pain methods, breastfeeding and maternal heart beat sound are effective in neonatal pain management. Breast milk odor has not been found to be an effective method in pain control, and its effectiveness should be investigated with new studies.CONTENTSTHESIS APPROVALDECLARATIONTHANK YOU …………………………………………………………………………… ....... iCONTENTS …………………………………………………………………………… .iiList of Abbreviations and Symbols ……………………………………………………………… .viList of Figures …………………………………………………………………………… ..viiList of Tables …………………………………………………………………………… viiiList of Attachments ……………………………………………………………………………… ... ix1. SUMMARY …………………………………………………………………………… ............. 12. SUMMARY …………………………………………………………………………… ... 23. INTRODUCTION and OBJECTIVE ………………………………………………………………… ............... 34. Definition of Pain …………………………………………………………………………… 64.2. Physiology of Pain …………………………………………………………………… ...... 64.3. Theories of Pain …………………………………………………………………………… ... 84.3.1. Gate control theory ……………………………………………………………. ……… ..84.3.2. Neuromatrix theory ………………………………………………………. …… .. ……… 94.3.3. Endorphin release theory ………………………………. ………………………………… 94.3.4. Interactive pain model ………………. ……………………………………………… ..… .94.3.5. Specificity (specificity) pain theory ……………. ………………………………………… .104.3.6. Pattern theory ……………………………………………………………….… 104.3.7. Intensive theory ………………. …………………………………………………………… 104.3.8. Psychological theories …………. ………………………………………………………… ..104.4. Classification of Pain ……………………………………………………………… .. …… 114.4.1. Classification of pain according to onset …………………………… ... ………… 114.4.2. Classification of pain according to neurophysiological mechanisms ………………. ……… .124.4.3. Classification of pain according to the region of origin ……. …………………………… 134.4.4. Classification according to sense type …………………………………… ... …………… .144.5. Description and Classification of Newborn ………………………………… .. ……….… ... 154.6. Development of Sensory Organs in Newborns ……………………………… .. …………… ..164.7. Pain in Newborn ……………………………………… ... …………………………… ... 194.7.1. Developmental dimension of neonatal pain …………………… .. ………………………… .204.7.2. Pain physiology in newborn …………………………… .. …………………………… .214.7.3. Pain symptoms in the newborn …………………………………. ……………………… ... 214.7.4. Effects of pain in the newborn ……………………………………. …………………… .224.7.5. Pain assessment in newborns …………………… .. ……………………… .234.7.6. Pain assessment tools in newborn ……… .. ………………………………… ..... 234.7.6.1. newborn pain and stress rating scale …………………… .. ………………… 254.7.7. Pain management in newborn ……………………………………………. ………. …… ... 264.7.7.1. pharmacological methods …………………………………………… ... …………. …… 274.7.7.2. non-pharmacological methods …………………………………………… .. …………… 334.8. Duties of Midwives and Nurses in Newborn Screening Tests …………………………… 424.9. The Roles of the Midwife and Nurse in the Management and Management of Pain in Newborns …… ... ……… ... 435. MATERIAL AND METHOD ……………………………………. …………………………… ..455.1. Purpose and Type of the Research …………………………………………………………… ..455.2 Place and Time of the Study …………………………………………………… 455.3. Study Population and Sample ……………………………………………………… .455.4. Recruitment Criteria …………………………………… .. …… ... ……………… .455.5. Work Exclusion Criteria ………………………………… ..... …………………… 465.6. Variables of the Study …………………………………………. …………………… 465.7. Research Hypotheses ……………………………………………. ………………… ..475.8. Data Collection Tools ……………………………………………………… .. ………… .475.8.1. Data collection form ………………………………………………………………… .475.8.2. ALPS-Neo neonatal pain and stress rating scale ………… ... ………………… 475.8.3. Application registration form …………………………………………. ……………………… 485.8.4. Pulse oximeter …………………………………. …………………………………… ... 485.8.5. Fetal hand dopes ………………………………………………………………… .. …… ... 485.8.6. Voice recorder ………………………………. ……………………………………… ... 485.8.7. Speaker ……………………………………………………………………………… ... 485.9. Data Collection …………………………………………. ……………………… .485.9.1. Pre-application of the study …………………………………………………………… 495.9.2. Approaches and methods to be applied …………………………… ... …………………… 495.10. Statistical Methods to be Used in Data Analysis …………………… ... ……… 515.11. Ethical Aspect of the Study …………………………………………… .. ………………… ..515.12. Limitations of the Study ………………………………………………………. ……… 516. FINDINGS …………………………………………………………………………… 566.1. Findings Regarding Interobserver Compliance Scores According to Scale Total Scores… ..566.2. Findings Regarding the Cronbach Alpha Values of the Scale ……………………………… .. …… 576.3. Findings Regarding the Distribution of Parents' Demographic Data ……………………… 576.4. Findings Regarding the Demographic Characteristics of Newborns …………………… .. ……… ..586.5. Findings Regarding ALPS-Neo Scale Total Scores of Newborns …………. ……… 596.6. Findings Regarding Peak Heart Rate, SpO2 and Crying Time of Newborns ………… 606.7. Findings Regarding Gestational Age, Postnatal Age and Birth Weight of ALPS-Neo Total Scores ……………………………………………………………… .. ……………… 617. DISCUSSION AND CONCLUSION ……. …………………………………………… ... …………… 627.1. Discussion of Findings Regarding the Introductory Features of Newborns in the Groups ……… 637.2. Discussion of Findings Regarding ALPS-Neo Scale Total Scores of Newborns in Groups ……………………………………………………………………… ... ………… 647.3. Discussion of Findings Regarding Peak Heart Rate, SpO2 and Crying Time of Newborns in Groups ………………………………………………………………. ……… 667.4. Discussion of Findings Regarding Gestational Age, Postnatal Age and Birth Weight of Newborns in Groups ………………………………………………………………. ……… 687.5. Result …………………………………………………………………………. ………… 697.6. Suggestions ………………………………………………………………………… .. ……… 708. RESOURCES ………………………………………………………… ... ………… ......... 729. ANNEXES ……………………………………………………………………… ...… ......... 8110. CV ………………………………………………………………… .. ………… 92